Retrospective Study
Copyright ©The Author(s) 2022.
World J Gastroenterol. Feb 28, 2022; 28(8): 840-852
Published online Feb 28, 2022. doi: 10.3748/wjg.v28.i8.840
Table 1 Baseline characteristics of the study population
VariablesBefore matching
After matching
ESD (n = 123)
Surgery (n = 562)
P value
ESD (n = 119)
Surgery (n = 119)
P value
Age, yr, mean SD55.3 12.453.0 11.8< 0.00156.6 11.955.6 11.90.546
Male, n (%)68 (55.3)282 (50.2)0.30567 (56.3)57 (47.9)0.194
Comorbidity, n (%)
Hypertension44 (35.8)143 (25.4)0.02041 (34.5)40 (33.6)0.891
Diabetes21 (17.1)65 (11.6)0.09519 (16.0)15 (12.6)0.459
Cerebrovascular disease8 (6.5)18 (3.2)0.1137 (5.9)2 (1.7)0.171
Respiratory disease7 (5.7)29 (5.2)0.8116 (5.0)6 (5.0)-
Liver disease3 (2.4)26 (4.6)0.2753 (2.5)3 (2.5)-
Renal disease2 (1.6)4 (0.7)0.2941 (0.8)1 (0.8)-
ASA physical status1, n (%)0.0220.254
1101 (82.1)503 (89.5)100 (84.0)106 (89.1)
222 (17.9)59 (10.5)19 (16.0)13 (10.9)
Tumor location, n (%)< 0.0010.822
Upper third8 (6.5)55 (9.8)8 (6.7)6 (5.0)
Middle third97 (78.9)321 (57.1)93 (78.2)93 (78.2)
Lower third18 (14.6)186 (33.1)18 (15.1)20 (16.8)
Lesion size, mm, n (%)0.4300.418
1030 (24.4)105 (18.7)28 (23.5)19 (16.0)
10-2050 (40.7)224 (39.9)50 (42.0)49 (41.2)
20-3024 (19.5)133 (23.7)22 (18.5)28 (23.5)
> 3019 (15.4)100 (17.8)19 (16.0)23 (19.3)
Gross morphology type1, n (%)0.3150.760
Elevated33 (26.8)127 (22.6)29 (24.4)27 (22.7)
Flat or depressed90 (73.2)435 (77.4)90 (75.6)92 (77.3)
Helicobacter pylori infection, n (%)64 (51.2)316 (56.2)0.39761 (51.3)60 (50.4)0.897
ESD indication, n (%)0.1830.183
Within expanded indication80 (65.0)329 (58.5)78 (65.5)68 (57.1)
Beyond expanded indication43 (35.0)233 (41.5)41 (34.5)51 (42.9)
Histology appearance, n (%)< 0.0010.794
Poorly differentiated carcinoma56 (45.5)151 (26.9)52 (43.7)54 (45.4)
Signet ring cell carcinoma67 (54.5)411 (73.1)67 (56.3)65 (54.6)
Table 2 Clinical outcomes and adverse events of early gastric cancer resection according to treatment modality
Variables
ESD (n =119)
Surgery (n = 119)
P value
Median hospital stay, d (IQR)4.0 (4.0-5.0)9.0 (8.0-9.0)< 0.001
ICU admission, n (%)1 (0.8)0 (0.0)-
30-d readmission, n (%)3 (2.5)12 (1.7)2-
Operation-related death, n (%)1 (0.8)0 (0.0)-
Complication, n (%)14 (11.8)7 (5.9)0.110
Bleeding (early/late)8/00/0
Perforation (early/late)5/0N/A
Pneumonia (early/late)1/00/0
Anastomosis site leakage (early/late)N/A1/0
Adhesion or bowel obstruction (early/late)0/01/2
Hernia (early/late)N/A1/2
Table 3 Incidence and characteristics of recurrent tumors after initial treatment (endoscopic submucosal dissection or surgery)
Variables
ESD (n = 119)
Surgery (n = 119)
P value
Recurrence, n (%)7 (5.9)2 (1.7)0.171
Local recurrence4 (3.4)N/A
Adenoma0 (0.0)N/A
Cancer4 (3.4)N/A
Differentiated3 (2.5)N/A
Undifferentiated1 (0.8)N/A
Synchronous lesion0 (0.0) 1 (0.8)
Adenoma0 (0.0)0 (0.0)
Cancer0 (0.0)1 (0.8)
Differentiated0 (0.0)0 (0.0)
Undifferentiated0 (0.0)1 (0.8)
Metachronous lesion3 (2.5)0 (0.0)
Adenoma1 (0.8)0 (0.0)
Cancer2 (1.7)0 (0.0)
Differentiated1 (0.8)0 (0.0)
Undifferentiated1 (0.8)0 (0.0)
Distant metastasis0 (0.0)1 (0.8)
Table 4 Clinical and tumor information for recurrent patients
Age
Sex
Location
Size (mm)
Morphology
Histology
Initial treatment
Recurrence type
Pathology of recurred lesion
Recurrence location
Recurrence time (mo)
Treatment for recurred lesion
61FMiddle 1/36FlatSRCESDMetachronous lesionUndifferentiated cancerLower 1/370ESD
62MMiddle 1/322FlatSRCESDLocal recurrenceUndifferentiated cancerMiddle 1/36Surgery
68FMiddle 1/368FlatPDAESDMetachronous lesionDifferentiated cancerUpper 1/350ESD
46MMiddle 1/360FlatPDAESDLocal recurrenceDifferentiated cancerMiddle 1/33Surgery
50FMiddle 1/325DepressedPDAESDLocal recurrenceDifferentiated cancerMiddl1 1/312ESD
62MMiddle 1/340ElevatedPDAESDLocal recurrenceDifferentiated cancerMiddle 1/36Surgery
56FLower 1/38FlatPDAESDMetachronous lesionAdenomaMiddle 1/323ESD
66MLower 1/315FlatPDASurgerySynchronous lesionUndifferentiated cancerUpper 1/35Surgery
64MMiddle 1/310ElevatedSRCSurgeryDistant metastasisUndifferentiated cancerPeritoneum122Conservative care
Table 5 Cox proportional hazard model for risk of recurrence after initial treatment
Variables
Adjusted hazard ratio (95% confidence interval)
P value
Treatment modality
Surgery1.0
ESD5.2 (1.0-25.8)0.045
Indication with any treatment modality
Within expanded indication1.0
Beyond expanded indication1.4 (0.4-5.4)0.585
Indication with ESD
ESD for the lesion within expanded indication1.0
ESD for the lesion beyond expanded indication2.8 (0.6-12.4)0.183